title: Outcome after two-patch repair of complete common atrioventricular canal defects in patients weighing four kilograms or less.
abstract: BACKGROUND
  Early repair of a complete common atrioventricular canal defect (CCAVCD) may benefit patients who exhibit congestive heart failure and failure to thrive. However, concern about increased risk and fragility of valve tissue has commonly led to delaying the surgical repair until the patients achieve a predetermined weight. We report our experience with a strategy of early repair independent of age or weight.
  
  
  METHODS
  Between 2003 and 2009, 32 patients underwent two-patch repair of CCAVCD at our institution; 22 patients weighed between 2.5 and 4 kg (group #1) and 10 weighed more than 4 kg (group #2). Medical records and echocardiographic studies were reviewed to determine whether there was a difference in the incidence of mortality, rate of reintervention, and complications between the two groups.
  
  
  RESULTS
  Operative mortality was 3.1% (1 of 32), with one additional death two years after repair, for an overall mortality of 6.25%. Median duration of mechanical ventilation, median hospital stay, and intropic score was similar between both groups. Freedom from valve reintervention was 91% in group #1 (20 of 22), and 89% in group #2 (8 of 9, p = 1.00).
  
  
  CONCLUSIONS
  Complete common atrioventricular canal defect can be repaired safely and effectively in patients under 4 kg. Although mortality was not increased, smaller patients have a tendency for longer intensive care and hospital stay as well as a higher incidence of atrioventricular valve regurgitation. However, valve function improved during the period of follow-up and did not impact the freedom from reintervention.
authors.affiliation: Department of Anesthesia and Critical Care, A.I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Levenbrown
authors.forename: A Majeed
authors.initials: AM
authors.lastname: Bhat
authors.forename: Jobayer
authors.initials: J
authors.lastname: Hossain
authors.forename: Christopher
authors.initials: C
authors.lastname: Derby
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
keywords: common atrioventricular canal defect; complications; congenital heart surgery; endocardial cushion defect; morbidity); outcomes (includes mortality; surgery